| Suicide is one of the most tragic issues in mental health. Suicide has traditionally been studied as an outcome of specific psychiatric disorders. The goal of this study was to consider whether there might be underlying dimensions across psychiatric disorders that are related to suicidality. This study proposed a transdiagnostic model of suicidality. Psychiatric symptoms were hypothesized to load onto three factors: Negative Mood, Impulsivity, and Arousal. Factors were then examined as predictors of suicidal ideation and suicide attempts. Data were drawn from the National Comorbidity Survey- Replication Study (NCS-R). Structured interviews were conducted in two parts using the Composite International Diagnostic Interview (CIDI). All survey respondents (N = 9,282) were administered the core diagnostic assessment. Those who met criteria for a psychiatric disorder, met subthreshold lifetime criteria and sought treatment at some time in their life, or ever in their life made a plan to commit or attempt suicide were administered Part II of the interview and are the sample of interest in this study (N = 5,692). The sample was representative of non-institutionalized civilian adults ages 18 or older whose primary language was English. Factor analyses revealed three modified factors: a Negative Mood/Emotional Arousal factor, a Negative Thinking factor, and a Recurrent Substance Use factor. Negative Mood/Emotional Arousal was a strong predictor of suicidal ideation. Suicidal ideation mediated the relationship between Negative Mood/Emotional Arousal and suicide attempts, controlling for Negative Thinking. Negative Thinking, Recurrent Substance Use, and suicidal ideation predicted suicide attempts. When number of suicide attempts was examined as the dependent variable, the model did not fit the data, suggesting that these factors were not as helpful in predicting highly recurrent suicide attempts. Recurrent Substance Use moderated the relationship between Negative Mood/Emotional Arousal and suicide attempts, demonstrating that, as negative mood increases, people with high levels of recurrent substance use are more likely to make a suicide attempt compared to people with mean or low levels of recurrent substance use. In sum, results of this study support two distinct pathways to making a suicide attempt: a direct relationship between negative thinking and suicide attempts, as well as an interaction between negative mood/emotional arousal and recurrent substance use. Several limitations including issues of sampling, the cross-sectional nature of the data, self-report bias, and the structure of the CIDI instrument, were taken into account in interpreting the results. Clinical implications and future directions for research are discussed. |
